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135 c A letter sent to 5 [4] [4,5] Drug Testing Drug Analysis and [3] 2009 John Wiley & Sons, Ltd. c . Kicman , Drug Control Centre, King’s ch Unit, University of Glamorgan, of Wales Institute, Cardiff, UK Peter Evans, Bruce and Andrew 4 7 2,3 iversity of West of Scotland, Glasgow, UK newspaper identified the doping regime of Mr Dwain Cardiff School of Sport, University RoyalGwentHospital,Newport,Gwent,UK Kingston University, Penrhyn Road, Kingston upon Thames, Surrey, UK Drug Control Centre, King’s College London, UK Division of Sport, Un Health and Exercise Science Resear Pontypridd, UK The Newman CentreCollege, for Birmingham, UK Sport and Exercise Research, Newman University Correspondence to: Michael R. Graham, Newman Centre forResearch, Sport Newman and University Exercise College, Birmingham, UK. E-mail: [email protected] Correspondence for drug analysis to: A. T College London. E-mail: [email protected] A recent doping violation, contravening the WADA code, has business. The acute adverse effects from contaminated vials ∗ lopment of the abscesses. Users of AAS and hGH for sport, 4 5 6 7 3 2 1 couraged the abuse of expensive drugs, particularly human ∗∗ illustrated the excessivewhich ‘‘polypharmacy’’ is in believed the to be athletic the world, tip of the iceberg. and image-enhancing drugs by female athletes;assessment this of has the led type to of an drugs they use. The Times Chambers, a disqualifiedtaking combinations international of prohibited substances. athlete, who admitted rsonal use. The substantial increase in this market has opened tablets was performed by a World Anti-Doping Agency (WADA) d as a viable method of achieving a perfect physique. They are David Cowan g to the exponential rise in drugs used for image enhancement. 7 cause of counterfeit and poorly controlled products. Copyright Julien S. Baker, [1,2] 1 Stephen-Mark. Cooper, 4 Paul Ryan, 1,2 In the US, significant quantities ∗ [2] Christopher J. Walker, , 135–142 Copyright 1 6 , ∗ 7 2009 Non-Eleri Thomas, In the UK, AAS and recombinant human growth 2 [1] AAS; abscess; cosmesis; image; performance

The analysis of 38 parenteral samples and 19 oral samples of Several countries, including , Argentina, Brazil, , Keywords: 2009 John Wiley & Sons, Ltd. including , are currently risking their health be accredited laboratory, in an attemptinjectable to AAS establish the and extentcommensal 21% of organisms, (4) available of which counterfeit the may products. oral have Fifty-three per tablets contributed cent were to (20) counterfeit. the of Culture deve the and sensitivity revealed the presence of hormone (rhGH) are controlledMisuseofDrugsAct1971.Thereisanexemptionfromrestrictionon under Schedule 4, Partthe possession 2 of of these substances, the whenproduct they and are are in for a self-administration. medicinal legal As control, a AAS consequence can of only be this usefromsourcesofunknownprovenance,suchastheblackmarket obtained in the UK for non-medical or the Internet. Theseaccordance products with are Good not Manufacturing necessarilycase Practice, with produced licensed as in would obtained from be legitimate sources.particular the Of concern is the use of anabolic as performance- of AAS emanate fromand Mexico, Greece. as well as from Russia, Romania, Drug Test. Analysis growth hormone (hGH), resulting in increased importationup for avenues pe for counterfeiting, estimated asmay a result multi-million in pound a variety ofrequiring pathologies surgical including treatment, communicable led diseases. us In to 2007, study in samples the obtained UK, from a the series underground of market. intramuscular abscesses, and sale ofrestricted. these This sale products is made tomail. easier Most overseas because AAS of found customers the in Internet iswithin originate and not e- also the only from European not countries UnionTurkey, Egypt, India and and Pakistan. Russia but also from Thailand, the UK and the USAAS have are legislation readily to obtainable control fromcountries AAS. permit many Nevertheless, the sale sources of AAS worldwide. without a Many medical prescription Introduction Yearly reports fromdemonstrate that anabolic-androgenic steroids the (AAS) are the most Worldabused group Anti-Doping of Agency drugsadvances in in detection (WADA) techniques competitive and severe sport, penalties for despitetest positive results. enormous Drugs such as anabolic-androgenic steroidsalso (AAS) the are most perceive widely abused drugs in sport. The Internet has en The current drastic escalation in obesity may be contributin Sue Easmon, image-enhancing drugs Michael R. Graham, (www.drugtestinganalysis.com) DOI 10.1002/dta.30 Counterfeiting in performance- and Research Article Received: 10 February 2009 Revised: 16 April 2009 Accepted: 16 April 2009 Published online in Wiley Interscience: Davies, T. Kicman . , + H] et al + 1 mm, . L) were 2 C, Turbo µ , 135–142 ◦ for 5 min. × 1 , g 2009 [6] Michael R. Graham C. The mobile phase consisted ◦ C, respectively. Helium was used Drug Test. Analysis ◦ L. g of each substance was transferred - solution (50 ng), 5 ml µ µ 3 C, was held for 5 min. Injections (1 ◦ g/mL of thyroxine was prepared in methanol : water µ m particle size) heated to 35 µ This was coupled to an Applied Biosystems API 3200 triple The tablet extract gave a peak consistent with the retention Full scan analysis (mass range m/z 80–650) was used for 8 . 1 quadrupole mass spectrometeroperating with in a Turboconditions the were Ionspray source positive heater source probe temperature 500 mode. The optimized source Ionspray voltage 5500 V, curtain gas settingsetting of of 15 psi, 6, collision ion gas setting source of 50 gas psi, 1 declustering potential setting ofof 65 of V, 10 45 entrance V, psi, potential cell ionThe exit source mass potential gas spectrometric 2 of method 51(mass V, was range and set m/z collision up 500–780)dissociation energy to produced of of detect by 35 V. the m/z after collision 777.2, induced the protonated molecule [M (product ion scan). times (4.68 min) andprotonated molecule product was visible ion at m/zdissociation spectrum 777 resulted and in for collision the induced formation thyroxine. ofconsistent m/z The with 731, those 634 and reported 605 previously. are temperature, 320 of potassium hydroxide (0.1 M)The and 5 contents mL of were hexane, were mixed added. thoroughly and then centrifuged at as the carrier gas and thepurposes, flow rate the was mass 0.7 mL/min. spectrometer Forion screening was monitoring mode operated (SIM) in usingbis-trimethylsilyl an the (TMS) ion derivative selected specific for for each compound. theare The mono summarized details in or Table 1. identification of the compounds detected.conditions The are described chromatographic above. LC-MS/MS analysis of thyroxine A tablet from atube bag containing labelled 10 mL ‘’thoroughly of was by methanol. placed sonication The into and contents a centrifuged were at mixed 1320 Then 0.8 mL of the supernatant was takenmethanol and : diluted water to 5 containing mL 0.1% with formiccontaining 1 acid (70 : 30). Acontaining solution 0.1% formic acid (70was : 30). transferred to A autosampler portion vials ofChromatographic and separation these was analysed performed solution on by an Waters LC-MS/MS. Acquity UPLCsystemusingaZorbaxEclipseXDB-C18column(50 Analysis of products A statistical sign test was applied to Tables 2 to 5. Analysis of PIED tablets (Table 2) Nineteen products were analysed.placed into Oral tubes products containing 10 (tablets)mixed mL of were thoroughly methanol. by The tubes sonication5 were min. then The equivalent centrifuged of 1–5 atto 1320 g a for glass tube, 0.1 mL of d of 0.1% formic acid (v/v) (solvent A) andformic methanol acid containing 0.1% (v/v) (solvent B).30% A gradient B, was increasing employed starting toand at 55% returned B to in theequilibrated 2 initial for min conditions a and further in 0.7 to 9.3 min.The min 75% The and volume flow B was rate allowed 10 in was to 0.25 8.66 mL/min. min made in the splitlesstemperatures mode; were 250 the and 280 injection port and transfer line C ◦ 2009 John Wiley & Sons, Ltd. c -diol and β ,17 ]-Testosterone α 3 C/min. The final ◦ H 2 Copyright C/min, then from 220 to Cat14 ◦ ◦ Cat8 ◦ e (MSTFA), pyridine and methoxy- e, , testosterone, -diol were purchased from Steraloids β ,17 β I) and formic acid (Analar, BDH) were -diol, 19-norandrost-4-ene-3 -diol, androst-4-ene-3,17-dione and levo- 4 α β ,17 ,17 m). The initial column temperature was 180 β β µ C/min and from 250 to 320 11 . ◦ Cat3 ◦ T) was purchased from LGC Promochem (Teddington, UK). The use of performance-enhancing drugs is contrary to all 3 Drug Testing Drug Analysis and (Newport, RI, USA). , methenolone andenanthate methenolone (Primobolan-Depot) were obtained from Schering Ger- many. DHEA, Sustanon 250 (, , testosteronedecanoate), phenylpropionate Durabolin ( and phenylpropionate) and Deca- testosterone Durabolin () were obtained fromClenbuterol Organon. sulphate wasacetate obtained was from obtained K. fromtainedfromCIBA.StanozololwasobtainedfromSterling-Winthrop. Thomae. Farmitalia. Methandienone wasBoldenone ob- was kindly donated by Professor Don Catlin of UCLA. 19-norandrost-4-ene-3 Olympic values andathletes. Peer influence creates and the information that negative AAS administered byintra-muscular(IM)injectionare‘lessharmful’thanoralproducts role modelshas for increased young the usefrequency of of IM IM preparations. abscessesseen The by in one escalation of a us in (MRG), cohort was the consideredof of to be non-sterilized bodybuilders as or a in result contaminated of the 2007, counterfeitfrom use products the obtained black market. Thesecurrent injectable, abscesses led and oral to performance- an andenhancing image- analysis of drugs the (PIED)bodybuilders in presently the UK. being used by competitive Androst-5-ene-3 www.drugtestinganalysis.com Gas chromatography-mass spectrometry conditions Gas chromatography-mass spectrometry (GC–MS)carried out on analysis an Agilent was 5973an mass Agilent selective 6890 detector GC coupled system to with anGC Agilent 7683 was autosampler. The fittedcolumn with a (HP-1; cross-linkedthickness length polymethylsiloxane 0 capillary 25 m; internal diameter 0.2 mm; film Methods The generic name of the drug was identifiedspecified from on the brand the name, label. If moreformula was than analysed, one they drug were of provided by theand different same individuals generic had differentavoid cross-contamination brand all vials names weresensitivity analysed (C and for & culture S) different prior and to analysis packaging. for chemical To formulaic content. Dodecane, potassium hydroxide (KOH), anhydrous sodium sulfate and hexane, all analyticalliquid reagent cromatography grade, and (HPLC)-grade high-performance methanolwere purchased and from cyclohexane Fishermonium Scientific (Loughborough, iodide UK). Am- (NH Materials for 1 min; this was ramped to 220 (d purchased from VWR International (Lutterworth, UK). N-Methyl-N- trimethylsilyl-trifluoroacetamid androst-5-ene-3 lamine hydrochloride, ,19-norandrost-4-ene-3,17-dion 19-nortestosterone, 250 thyroxine were purchased from Sigma-Aldrich (Poole, UK). Purified water was obtainedter from Systems, ELGA Purelab High Maxima Wycombe, (Vivendi UK). Wa- [16,16,17-

136 137 L) C. [7] ◦ µ 13.1 time (min) Retention Drug Testing Drug Analysis and www.drugtestinganalysis.com L of methoxylamine hydrochloride (8% µ and relative (%) (80), 434(50) 11.6 (80), 434(50) 12.3 344 344 (m/z) 435 (80), 356(15), 143(15) 14.7 Cfor1hwith50 ◦ 446 abundances (100), 403(10), 194(7) 12.4 (100), 401(12), 208(5) 15.8 Steroids in which the tri-ene-one system is present, such as (100), 401(9), 194(8), 234(6) 12.0 (100), 443(19), 99(8), 208(5) 19.2 (100), 329(8), 155(5), 485(4) 22.2 (100), 415(10), 194(7), 234(7) 12.8 (100), 417(13), 208(8), 209(8) 13.1 (100), 155(10), 343(8), 499(5) 22.6 418 416 (100), 457(10), 113(10), 208(6) 20.4 (100), 438(40), 401(20), 421(8) 17.7 (100), 105(12), 194(10), 463(5) 22.3 (100), 477(10), 105(15), 343(3) 22.7 (100), 469 (8), 343 (5), 209 (10) 21.9 (100), 385(20), 400(10),330(10) 19.3 (100), 240(20), 182(16), 330(15)(100), 240(19), 182(18), 330(15) 10.4 11.4 (100), 430(70), 415(25), 325(20) 12.8 (100), 157(45), 448(30), 433(10) 12.9 (100), 417(70), 327(35), 303(15) 12.0 (100), 446(25), 208(25), 179(20)(100), 444(60), 339(25), 429(12) 13.7 14.3 (100), 194(20), 302(15), 427(15) 14.3 (100), 486(25), 208(25), 179(20) 20.7 (100), 524(35), 325(20), 191(20) 23.1 The presence of recombinantpeptide hGH mass (22.1 mapping kDa) (12 peptides was identified). confirmed by w/v in pyridine). Followingdodecane derivatization, (98 : 2 2 mL v/v) and oflayer 0.5 was cyclohexane: mL removed and of anhydrous water sodium were sulphatethe added. was organic added The to water layer, whichThe was organic then fraction decantedderivatized by into was trimethylsilylation and a analysed by evaporated full-scan clean GC-MS, as to tube. described above. dryness, the residue Analysis of vials for human growth hormone (Tables 4 and 5) Vials purported to contain hGHand were following subjected digestion to direct with analysis desorption trypsin, ionization using time matrix-assisted of laser TOF/MS) flight, and mass peptide spectrometry mass (MALDI- mapping, as described elsewhere. were taken and evaporated to dryness under nitrogen at 60 and ,well do not with derivatize performed the using a different derivatizing above technique to form amethyloxime procedure stable trimethylsilyl derivative. and Methanolic extracts (50 a repeat analysis was The residues were derivatized toat form 60 methyloximes by heating (100), 335(45), 337(30), 300(20) 5.8 416 458 500 430 432 514 86 436 472 478 492 484 143 420 420 206 141 432 195 206 442 195 206 Characteristic ions 2009 John Wiley & Sons, Ltd. c C. The ◦ L portion µ L) were taken and the µ L of dodecane was added and the -diol bis TMS -diol bis TMS µ L of a mixture containing N-methyl-N- β β µ , 135–142 Copyright ,17 ,17 1 α β , -diol bis TMS 129(100), 239(90), -diol bis TMS 129(100), 239(90), α β ,17 ,17 2009 β β GC-MS characteristics of compounds analysed Cfor15minwith40 ◦ The contents were transferred to glass vials and a 200 The selected ions monitored for screening purposes are marked in bold (full scan was used for identification). Compound (as trimethysilyl derivative; TMS) clenbuterol bis TMS Table 1. 19-norandrost-4-ene-3 19-norandrost-4-ene-3 androst-5-ene-3 19-norandrost-4-ene-3,17-dione bis TMS dhea bis TMS androst-5-ene-3 nandrolone bis TMS bis TMS androst-4-ene-3,17-dione bis TMS mesterolone bis TMS testosterone bis TMS methenolone bis TMS methandienone bis TMS d3-testosterone bis TMS norethisterone bis TMS methyl testosterone bis TMS 301(100), testosterone propionate TMS TMS testosterone isocaproate TMS methenolone enanthate TMS TMS TMS TMS nandrolone decanoate TMS nandrolone phenylpropionate TMS TMS testosterone phenylpropionate TMS boldenone undecenoate TMS Counterfeiting in performance- and image-enhancing drugs Drug Test. Analysis 1320 g for 5to min. 2 mL The of hexaneat 95% layer 1320 methanol, g was mixed fordiscarded. removed The thoroughly 5 methanolic layer and then was minutes. evaporated centrifuged added a to The dryness under hexane steady layer streamto was form of removed ether-TMS nitrogen.60 and and/or The enol-TMS derivatives residues by were heating derivatized at of each wastubes. taken The and contents were added mixed thoroughlyat to and 1320 then g 10 centrifuged for mL 5 min. of Methanol extracts methanol (200 in 20 mL Analysis of AAS vials and sachets (Tables 3, 4 andThe 5) contents ofthe the sachets vials were were for topicalproducts. intended application. for There were injection 38 whereas different samples were analysed by SIMabove. and full-scan GC-MS as described solvent was evaporated to dryness under nitrogen at 60 trimethylsilyltrifluoroacetamide (MSTFA), ammonium iodideethanethiol and (1000/3/9 v/w/v). Following derivatization,were the tubes allowed to cool, 20 residues were derivatized toanalysed by form full-scan GC-MS, trimethylsilyl as derivatives described above. and . The et al , 135–142 1 , 2009 Michael R. Graham Drug Test. Analysis on 100 manufactured by Organon, oducts had different labels) ) and bodybuilding web sites, reveals that Abcess of the right biceps. - α A comparison of the formal reference literature (Martindale: Complete Drug Reference illegal laboratories are concocting theircontents, own as names and exemplified product bywhich is sample not 5, a recognized Trenbolone(and brand 80 the name vial in (Table 4), contained the reference trenbolonethan literature esterified the with acetate claimed rather enanthate, both of which are supplied by a Figure 1. Discussion A number of tablets andwere a found large to be proportion counterfeit, of containing steroids the otherindicated injectable than those AAS or no steroidwas at a all. The vialcounterfeit most labelled as ‘sophisticated’ it ‘Sustanon’ example contained testosterone (Tablebeing enanthate, 4, an this active sample ingredient amongst not the 4),in testosterone either Sustanon esters which 250 or listed Sustan was the legitimate pharmaceutical company. vided by bodybuilders and all pr  2009 John Wiley & Sons, Ltd. c Copyright 05). . C. Aerobic cultures were examined ◦ 0 < p Oral PIED analysed by GC-MS and LC-MS/MS (products were pro Product label Product found Of the 19 orally active preparations (Table 2), four samples were Microbiological culture of the vials revealed the presence of Saooo 5 123 Clenbuterol (Spiropent)4Stanozolol Salbutamol5 Stanozolol67 Methandienone8 Stanozolol9 Oxymetholone10 Oxymetholone11 Methandienone Methandienone12 Stanozolol13 Ephedrine14 Furosemide15 Stanozolol16 Ma Huang17 Clenbuterol Clomiphene citrate18 Levothyroxine19 Clenbuterol Mesterolone (Proviron) Salbutamol No anabolic steroids Methandienone detected Stanozolol Oxymetholone Methandienone Methandienone Stanozolol Ephedrine Furosemide Clomiphene Methyl testosterone and caffeine Ephedrine Mesterolone Thyroxine Clenbuterol Table 2. Drug Testing Drug Analysis and labelled ‘stanozolol’ but only one containedtwo this anabolic of ; theand remaining one three contained contained nolabelled other active contained ingredient. the anabolic correct All steroids contents. thefor From parenteral other 38 use, vials products 18 or samples sachets the contained label (Table what 3). was Eight described samples contained on what something other was than on theactive drug label (Table 5). (Table 4). Twelve samples contained no contaminants, identified as skinright biceps commensals. abscess Figure and 1 Figure 2an shows shows abscess wall the a scraping microphotograph taken of during surgery. for bacterial growth afterexamined 24 after 48 and h 48 and h. again after Anaerobic 5 days. cultures were www.drugtestinganalysis.com Results Retention times and fullobtainedfromanalysisofstandardsanddrugssuppliedbylicensed scan spectra werepharmaceutical compared companies. to The results those ofanalysis, tablet, obtained sachet from and the vial in underground Tables market, 2–5. are Of displayed (42%). The the statistical sign 57 test applied samples to Tablessignificance analysed, 2–5 in 24 all demonstrated groups were ( counterfeit system (Oxoid). The second agar plateAll plates was were incubated incubated at aerobically. 37 One hundred microlitrestwo of agar each plates sample (Oxoidhad Ltd, was Basingstoke, been UK), inoculated pre-reduced one overnight. onto ofthe which The inocula plates were using spread disposableplates over were plastic incubated spreaders. in Theatmosphere 3.5 pre-reduced L generated anaerobic jars using with an anaerobic the catalyst-free ‘Anaerogen’ Microbiological culture of drug samples

138 139 Drug Testing Drug Analysis and dandIdentifiedbyanalysis www.drugtestinganalysis.com T. Propionate, t. Cypionate, T. Decanoate T. Propionate, T. Phenylpropionate T. Decanoate, T. Enanthate Nandrolone decanoate Nandrolone decanoate T. Propionate, T. Phenylpropionate, T. Isocaproate, T. Decanoate T. Propionate, T. Phenylpropionate, T. Isocaproate, T. Decanoate T. Propionate, T. Phenylpropionate, T. Isocaproate, T. Decanoate T. Propionate, T. Phenylpropionate, T. Isocaproate, T. Decanoate Primobolan Methenolone enanthate T. Enanthate T. Enanthate T. Enanthate Stanozolol s (steroids or hGH) contrary to that stated on the label. 2009 John Wiley & Sons, Ltd. aimed Product found c oils,te3,3ml’ T. Phenylpropionate, T. Isocaproate, T. Decanoate Product label(different manufacturer) Product claime (different manufacturer) (different manufacturer) (different manufacturer) (different manufacturer) (different manufacturer) (different manufacturer) (different manufacturer) (different manufacturer) (different manufacturer) (different manufacturer) (winstrol depot) , 135–142 Copyright 1 , 2009 Products marketed for injection that contained compound Products marketed for injection that were found to contain authentic material. Product label Product cl Testosterone. Testosterone. = = 56 Trenbolone 807 Unlabelled8 Sachet 1 Sachet 2 Growth hormone Www.821.in ‘tep, 3 ml’ Www.821.in ‘Indian aromatherapy rhGH material present (22 kda T. peak, Propionate only) T. 12 T.Propionate, Boldenona 503 Nandrolone decanoate4Sustanon Primobolan depot Nandrolone decanoate Methenolone enanthate T. Enanthate T. Propionate Nandrolone phenylpropionate Table 4. T. 1 Deca durabolin Table 3. 234Omnadren 5Sustanon Deca durabolin 6 Equipoise789Primobolandepot Sustenon ‘250’ 1011 Sustenon ‘250’ 1213 Parabolan14 Primobolan depot 1516 Boldenone Stanazol undecylenate 17 Testosterone enanthate 18 Testosterone enanthate Testosterone enanthate Testosterone propionate Trenbalone acitate Zambon Norditropin simplexx Trenbolone acetate Stanozolol T. Propionate Trenbolone acetate Growth hormone Counterfeiting in performance- and image-enhancing drugs Drug Test. Analysis . [13] et al , 135–142 1 , Although the Much more re- 2009 [12] [14] but the rationale [9] Michael R. Graham was included in [10] Drug Test. Analysis investigated the contents of 70 confiscated [15] . et al A survey on weightlifters in 2007, undertaken in the [11] The demand for AAS for performance and image enhancement It has been estimated that one million individuals in the US, quickness and reduceMr sluggishness’, Victor as Conte stated ofto in BALCO, provide a to him the letter withing athlete from the detailed Mr seven information Dwain different forusing Chambers, types UK (tetrahydrogestrinone, of Sport testosterone drugs regard- withhGH, he insulin, , was erythropoietin, modafinil purported andtent to liothyronine). of This be ex- polypharmacy byvery an common athlete amongst is bodybuilders perhaps whodrugs. use surprising Drugs image-enhancing but are not is are only used taken to to enhance counteractfects the the or body potential occurrence image side but of effectsuse any of tamoxifen other adverse to drugs. side counteract Forterone, the ef- example, males which of can excess lead testos- to gynaecomastia has led to anexisted expanding at a counterfeit sophisticated level market for – moreinvestigation a than a demonstrated market decade. that In that 15 1997, an has (36%)GC-MS of did not 42 contain the AAS expected ingredients. analysed by south Wales area of thewere regular UK, AAS users found and that that 7% were 70% females. of 146 respondents cently, Thevis number of users cannotis readily clear be that they determined, are it used throughout theby UK, as the discussed report in from depth the British Medical Association (BMA, 2002). products, where 17 (35%) of 48 compounds labelled as anabolic the drug regimen tomale bodybuilder be (Table used 6) by (personal communication a with UK MRG). nationalpredominantly competitive males fe- under 25users years of of AAS. Fifty age, per are centdrugs of current intramuscularly, these placing or young them adults past at administer riskinjection. of their infections related to for its usecal, by as female anabolic bodybuildersand steroid some may administration competitors causes at resortthat breast first to female shrinkage implant appear bodybuilders surgery. illogi- ducing have It to is a reasoned the muchwhich low more is levels difficult why time of oestrogenmatase re- body inhibitors antagonists fat such such as needed asoestrogen for antagonists tamoxifen or are or competition, letrozole thought are aro- defined to used. give and The the vascular physique lookcommunication a between more for ATK both and Mr mentant Anthony Roberts, and to a professional women consul- bodybuilders). (personal [8] aimed Product found 2009 John Wiley & Sons, Ltd. c ned no anabolic steroids or growth hormone Copyright Products marketed for injection which contai Microphotograph of abscess wall scraping taken during surgery Product label Product cl Testosterone = With respect to the non-steroidal drugs, three vials purported to T. 12 Boldabol3 Boldebal-h4 Mastabol5 Primobolan6 depot Spectriol7 Testabol8 depot Testex9 elmu prolangatum 250 Tesosterone10 cypionate injection (cypionax) Trenbol11 75-r Youthgh12 T. Cypionate Growth hormone Norditropin simplexx Boldenone T. undecylenate Cypionate Methenolone Boldenone enanthate undecylenate Dromastanolone dipropionate T. Cypionate T. Esters Growth Trenbolone Nil Somatotropin hormone acetate Growthhormone Nil Nil Nil Nil Nil Nil Nil Nil Nil Nil Nil Table 5. Drug Testing Drug Analysis and be GH (Table 5, sample 10,hormone 11, (or 12) steroid). contained It no is steroid not or surprisingthatcontainnohGH,especiallyaspharmaceuticalhGHisexpensive protein that counterfeits will exist compared with AAS. Conversely,sive thyroxine compared is to hGH relatively and thyroxine inexpen- wasin confirmed a to tablet be present provided for thisthe study. more Thyroxine active is a thyroidbe prohormone hormone for used tri-iodothyronine, to which may ‘help accelerate the basic metabolic rate, increase www.drugtestinganalysis.com shows muscle fasciclesdebris (b). (a) and acute inflammatory cells with necrotic company in Poland). Trenboloneas as the the acetate undecylenate andanabolic have agents boldenone and been were confirmed to used bewith present exclusively the in the legitimate products as brand names Parabolan veterinary andthe Equipoise. European Within Union, the use of thesegrowth veterinary promoters drugs is as banned. livestock Bodybuilders are knownveterinary to use preparations such and athletesthese are prohibited substances still (WADA Laboratory testing Statistics, 2007). positive for Figure 2.

140 141 [31] There . [30] Sports Med. Despite the 2008 [27] sport/athletics/artic Drug Testing Drug Analysis and . siness for the big ones. Search for 2008 w.items/d06243r.pdf, 3 November www.drugtestinganalysis.com hi/olympics/athletics/7403158.stm, There is a direct relationship between [28] . Contemporary research is providing evidence to , 505. 2008 [29] 38 , . 2008 author under http://www.playthegame.org, January prescription and present significant challenges to lawofficials, enforcement http://www.gao.gov/ne 2005 le3942201.ece, accessed 16 May 16 May [3] M. R. Graham, B. Davies, F. Grace, A.[4] Kicman, J. S. http://www.timesonline.co.uk/tol/sport/more Baker, [2] G. Hermansson, Doping trade: bu [1] R. J. Cramer, Anabolic steroids are easily purchased without a [5] http://news.bbc.co.uk/sport1/ is a need forthe the assurance of unlimited anonymity, provision embracingmethods of have the failed. fact Despite sterile the that information equipment being promoted all that with previous the administration of AAS bythan parenteral oral injection administration, is deaths lesshigh are harmful dose still usage, occurring irrespective from of chronic the mode of administration. the increase in performance-enhancingand drug use communicable and infections proportions. diseases, which are reaching pandemic for intervention and education to this population. provision of sterile needleshas and been syringes a pandemic todrug abuse increase user and currently in groups, 50% of hepatitis there suffering all with C recreational the drug from virus. abusers are recreational Conclusion The risk ofperformance and counterfeits image enhancement, andexposes including AAS users poorly and to hGH, enormous controlledproducts are health injected. products risks, especially for when these References educate and prevent the catastrophic effects of doping. [23] Ad- 2009 John Wiley & Sons, Ltd. c Gluteal This is [15] 66666 11111 11111 11111 22222 12221 45654 ) of ‘classic’ pectoral and [21,22] 1 [24,25] − [11,20] 1mg.g > ) Education and the unquestioned 1 ) 1 − Thigh abscesses, − hepatitis B, hepatitis C and human [26] [18–20] , 135–142 Copyright Mycobacterium smegmatis, Staphylococcus, 1 Due consideration should also be given to ) ) , 1 1 This unregulated manufacture may produce − ) − ,alternatedays) , 5 days.week 1 [17] ) 1 1 , 5 days.week 1 − 1 − − [16] − 2009 − .d .d .d .week 1 1 .d 1 1 1 − − − − .week − 1 AAS Regime of a current female UK bodybuilding champion weekly dose − = , 4 days.week Enteral administration daily dose 1 1 Subcutaneous (parenteral) administration Intramuscular (parenteral) administration − g.tablet = − = µ = = 1 − Contamination of vials with used needles would be an effective d Oral SC Growth hormone (Somatropin) (Jintropin) (SC) (IU.d IM ek54321 Week Drug Clenbuterol (Spiropent) (oral) (20 Table 6. week Testosterone propionate (IM) (150 mg.2ml Stanozolol (Winstrol) tablets (oral) (2 mg.tablet (Anavar) (oral) (10 mg.tablet Tamoxifen (Nolvadex) (oral) (10 mg.tablet Stanozolol (Winstrol) suspension (IM) (50 mg.ml Counterfeiting in performance- and image-enhancing drugs ministrationoflargevolumesoftestosteroneestersinoneinjection (up to 5 mL) is common,formation, exposing an where individual a to sterile pathogenic abscess organism cannot be found. possible adverse reactions to the vehicle used,particulates. as Individuals well as who the inject risk AAS of are alsocomplications known to develop from contaminated syringestion or techniques. non-sterile The injec- sharingthe of vials AAS are from ‘multi-dose’place, a vials, exposing legitimate individuals whether to source the or riskReported otherwise, of intramuscular is infections abscesses. common- associatedscesses with attributable to AAS injectionStreptococcus, include Pseudomonas, ab- immunodeficiency virus. anabolic steroids. provision of disposable of sterileto needles remains prevent a abscesses practical and way individuals. blood-borne Needle-exchange programmes infections currently between provide AAS such users with clean, sterile needles and may be a unique opportunity Drug Test. Analysis steroids did not contain orgredients. did Even the not counterfeit only packaging contain examinedwere in the hardly this distinguishable declared or study in- not distinguishable fromboxes. authentic Moreover, a study performed intritional 2001 supplements, and purchased in 2002 13 on different countries, 634 showed nu- that apart from low-level contamination with in a signif- icant proportion of non-hormonal supplements, othersactually that were declared by theterfeit suppliers as as they prohormones contained were high coun- amounts ( comparable to the sharingusers, who of inject street spoons drugs. among intravenous drug abscesses have also occurred in contaminated products. preparations that are contaminatedare of with poor infectious quality. agents and deltoid abscess have beenshots’ reported or in ‘site bodybuilders locations’, using whichmuscle, ‘spot believed are to local increase injections isolated muscle into growth. a specific means of transmitting blood-borne pathogens. , . 44 , et al Lancet , 644. , 1544. 2005 , 135–142 40 1 , , 207. , 372 , 105. , Lakartidningen 262 22 , , 2006 Your Patient and 2009 , 1467–79. 2008 , 357. , 352. 20 , 451. , 18 1989 1994 ,8. 325 , , 12 , 99. , 21 , Lancet Michael R. 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Sch 1]MTei,YShae,AToa,GSgud H.Geyer, G.Sigmund, A.Thomas, Y.Schrader, M.Thevis, [17] [16] F. Musshoff, T. Daldrup, M. Ritsch, [15] Board of Science and Education of the British Medical Association, [14] J. S. Baker, N. E. Thomas [12] http://www.anthonyrobertsonline.com/aboutme.html; 9[13] J. April D. Rich, B. P. Dickinson, T. P. Flanigan, S. E. Valone, [11] C. E. Devoto, A. M. Madariaga, C. X. Lioi, N. Mardones, [10] http://www.wada-ama.org/rtecontent/document/LABSTATS Drug Testing Drug Analysis and www.drugtestinganalysis.com

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